Needle holder for endoscope, suture set, and suture system

ABSTRACT

A needle holder includes: a flexible sheath portion which is capable of being inserted into an instrument channel of a flexible endoscope; a first grasping member which is rotatably coupled with a distal end portion of the flexible sheath portion; and a second grasping member which is provided in the distal end portion of the flexible sheath portion. In a state where a curved needle is grasped by a first grasping surface of the first grasping member and a second grasping surface of the second grasping member, the second grasping surface inclines such that a grasped region of the curved needle that is grasped by the first grasping surface and the second grasping surface is positioned between a distal end of the second grasping member and a needle tip of the curved needle in a direction of a center axis of the second grasping member.

This application is a continuation application based onPCT/JP2016/055678, filed on Feb. 25, 2016. The content of the PCTApplication are incorporated herein by reference.

TECHNICAL FIELD

The present invention relates to a needle holder for endoscope, a sutureset, and a suture system.

BACKGROUND ART

Conventionally, a needle holder that is used for suturing a tissue in abody is known (for example, Japanese Unexamined Patent Application,First Publication No. 2012-228311). A suture instrument for suturing thetissue of the body under a laparoscope in an operation using thelaparoscope is known (for example, Japanese Translation of PCTInternational Application Publication No. 2014-500756 and JapaneseTranslation of PCT International Application Publication No.2013-529981).

The needle holder having an insertion portion that is flexible and iscapable of being inserted into an instrument channel of a flexibleendoscope is known (for example, Japanese Unexamined Patent Application,First Publication No. 2009-183690).

SUMMARY OF INVENTION

A first aspect of the present invention is a needle holder that include:a flexible sheath portion which is longitudinal, flexible, and capableof being inserted into an instrument channel of a flexible endoscope; afirst grasping member which includes a first grasping surface and isrotatably coupled with a distal end portion of the flexible sheathportion; and a second grasping member which includes a second graspingsurface and is provided in the distal end portion of the flexible sheathportion. The second grasping surface inclines from a proximal end of thesecond grasping surface toward a distal end side of the second graspingsurface, the distal end of the second grasping surface is closer to thefirst grasping member than the proximal end of the second graspingsurface, and in a state where a grasped region of a curved needle isgrasped by the first grasping surface and the second grasping surface, aneedle tip of the curved needle positions closer to a proximal end ofthe flexible sheath portion than the grasped region of the curvedneedle.

The second grasping surface may incline in a range of 5° or more and 20°or less from the center axis of the flexible sheath portion.

The second grasping member may include a projection portion thatprojects from a distal end of the second grasping surface to the firstgrasping member side.

The second grasping member may include a groove part that extends from adistal end of the second grasping surface toward a proximal end of thesecond grasping surface. The width of the groove part may be larger thanthe width of the first grasping surface in a direction perpendicular toa center axis of the flexible sheath portion.

A second aspect of the present invention is a suture set that includesthe needle holder of the above aspect; and a curved needle that isgrasped by the needle holder. The curved needle includes a flat portionwhich is at least a portion of an outer circumference of the curvedneedle and is formed flatly in a cross-section perpendicular to a centeraxis extending along an arc of the curved needle, and in a state wherethe grasped region of the curved needle is grasped by the first graspingsurface of the first grasping member and the second grasping surface ofthe second grasping member, an orientation of the curved needle isrestricted such that the needle tip is positioned closer to a proximalend side than the flat portion by contacting the flat portion to atleast one of the first grasping surface and the second grasping surface.

A third aspect of the present invention is a suture system whichincludes: the needle holder; and an endoscope that includes: aninstrument channel into which the flexible sheath portion is inserted,and an imager that is configured to capture at least the first graspingmember and the second grasping member among the needle holder projectedfrom a distal end of the instrument channel. In a state where the curvedneedle is grasped between the first grasping member and the secondgrasping member, the second grasping surface inclines with an angle inwhich an orientation of the curved needle is configured to restrict suchthat a first straight-line distance from the imager to a center portionof the curved needle is equivalent to a second straight-line distancefrom the imager to a needle tip of the curved needle.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is an overall view showing a suture system of a first embodimentof the present invention.

FIG. 2 is an overall view showing a needle holder in the suture system.

FIG. 3 is a lateral view showing a treatment portion of the needleholder.

FIG. 4 is a lateral view of a grasped curved needle by the needleholder.

FIG. 5 is a cross-sectional view in A-A line of FIG. 4.

FIG. 6 is a view showing a state where the curved needle is stablygrasped by the needle holder.

FIG. 7 is a view showing a state where the curved needle is stablygrasped by the needle holder from a B direction of the FIG. 6.

FIG. 8 is a view showing a state where the needle holder is insertedinto a flexible endoscope.

FIG. 9 is a lateral view showing the treatment portion in the needleholder of a modified example of the embodiment.

FIG. 10 is a lateral view showing the treatment portion in the needleholder of another modified example of the embodiment.

FIG. 11 is a view showing the treatment portion in the needle holder ofthe modified example of the embodiment from a C direction of FIG. 10.

FIG. 12 is a lateral view showing a state where the needle holder of afurther another modified example.

FIG. 13 is a view showing a movement in which the curved needle isgrasped and a tissue is sutured using the needle holder of the modifiedexample.

FIG. 14 is a plan view showing a second grasping surface of a needleholder of a second embodiment of the present invention.

FIG. 15 is a front view showing a treatment portion of the embodiment.

FIG. 16 is a perspective view showing one configuration example of theneedle holder of the present invention.

FIG. 17 is a lateral view showing a modified example of a manipulationportion of the needle holder for an endoscope.

FIG. 18 is a cross-sectional view showing a modified example of atreatment portion of the needle holder for an endoscope.

DESCRIPTION OF EMBODIMENTS First Embodiment

One embodiment of the present invention will be described. FIG. 1 is anoverall view showing a suture system 1 of a present embodiment. FIG. 2is an overall view showing a needle holder 20 in the suture system 1.FIG. 3 is a lateral view showing a treatment portion 22 of the needleholder 20. FIG. 4 is a lateral view of a grasped curved needle 40 by theneedle holder 20. FIG. 5 is a cross-sectional view in A-A line of FIG.4. FIG. 6 is a view showing a state where the curved needle 40 is stablygrasped by the needle holder 20. FIG. 7 is a view showing a state wherethe curved needle 40 is stably grasped by the needle holder 20 from a Bdirection of the FIG. 6.

As shown in FIGS. 1 to 4, the suture system 1 of the present embodimentincludes a flexible endoscope 2, suture holder 20, and a curved needle40.

The flexible endoscope 2 includes an insertion portion 3, and amanipulation portion 8.

The insertion portion 3 includes an imager 4, an active bent portion 5,and a flexible portion 6 from a distal end in this order. An instrumentchannel 7 for inserting the needle holder 20 of the present embodimentis provided inside of the insertion portion 3. A distal end opening 7 aof the instrument channel 7 is provided in the distal end of theinsertion portion 3.

The imager 4 is capable of imaging a part that is a treatment target.The imager 4 is arranged in the distal end part of the insertion portion3 such that an optical axis X1 extends in a longitudinal direction ofthe insertion portion 3. The imager 4 can image a first grasping member23 and a second grasping member 26 (described later) of the needleholder 20 in a state where the needle holder 20 that is inserted intothe instrument channel 7 is projected from the distal end opening 7 a ofthe instrument channel 7.

The active bent portion 5 is capable of actively bending in accordancewith the manipulation which the operator of the flexible endoscope 2performs for the manipulation portion 8.

The manipulation portion 8 is connected to the flexible portion 6. Themanipulation portion 8 includes a grip 9 that is grasped by theoperator, an input portion 10 that receives the manipulation for movingthe active bent portion 5, a proximal end opening portion 7 b of theinstrument channel 7, and a universal cord 11 for outputting the imagethat the imager 4 captures outside. The universal cord 11 that isprovided in the manipulation portion 8 is capable of connecting to adisplay apparatus (not shown) via an image processing device (notshown).

A configuration of the flexible endoscope 2 of the present embodiment isnot limited by the above configuration. For example, a known flexibleendoscope that includes one or more channel may be appropriatelyselected as a flexible endoscope that is capable of using with theneedle holder 20. When the channel can be attached to the flexibleendoscope as an external channel, the flexible endoscope can be attachedto an external channel instead of the channel into which the needleholder 20 of the present embodiment is inserted, the channel may be notformed in the flexible endoscope.

A shown in FIG. 2, the needle holder 20 includes a flexible tube 21 thatis flexible and longitudinal, a therapeutic portion 22 that is arrangedin a distal end 21 a of the flexible tube 21, an operating portion 31that is arranged in a proximal end 21 b of the flexible tube 21, and anoperating wire 35 that is arranged inside of the flexible tube 21 andthat is connected to the operating portion 31 and the therapeuticportion 22.

The flexible tube 21 is capable of being inserted into the instrumentchannel 7 of the flexible endoscope 2 shown in FIG. 1. A distal end 21 aof the flexible tube 21 is capable of advancing from the distal endopening 7 a of the instrument channel 7 and retracting into theinstrument channel 7 in a state where the flexible tube 21 is insertedinto the instrument channel 7. The distal end 21 a of the flexible tube21 is capable of advancing into an imaging field of view of the imager 4of the flexible endoscope 2 and is captured by the imager 4.

As shown in FIGS. 2, 3, and 6, the therapeutic portion 22 includes thefirst grasping member 23 and the second grasping member 26 for graspingthe curved needle 40, and a connecting part 28 and a coupling shaft 29that are coupled with the first grasping member 23 and the secondgrasping member 26 such that the first grasping member 23 is capable ofopening and closing with respect to the second grasping member 26.

The first grasping member 23 is coupled with the distal end 21 a of theflexible tube 21 via the connecting part 28 and the coupling shaft 29. Aproximal end 23 b of the first grasping member 23 is connected to adistal end 35 a of the operating wire 35. The first grasping member 23includes a hole portion 23 c for coupling the first grasping member 23with the connecting part 28 via the coupling shaft 29 between the distalend 23 a and the proximal end 23 b of the first grasping member 23. Asurface that is faced on the second grasping member 26 in the firstgrasping member 23 includes a first grasping surface 25 that is capableof contacting with the curved needle 40. The first grasping surface 25is parallel to a second grasping surface 27 (described later) of thesecond grasping member 26 in a state where the curved member 40 isgrasped by the first grasping member 23 and the second grasping member26.

The second grasping member 26 is coupled to the distal end 21 a of theflexible tube 21 via the connecting part 28 so as to extend in a centerline (center axis) Y1 direction of the flexible sheath portion 21. Inthe present invention, the second grasping member 26 and the connectingpart 28 are integrally molded. The second grasping member 26 includesthe second grasping surface 27 that inclines with respect to the centerline Y1 of the flexible tube 21 and is faced on a proximal end 26 b sideof the second grasping member 26. That is, as shown in FIGS. 3 and 6, ina side view of a direction in which the coupling shaft 29 extends, thesecond grasping surface 27 (line connecting a proximal end of the secondgrasping surface 27 with a distal end) inclines so as to be a sharpangle at a proximal end side of the second grasping surface 27 withrespect to a line parallel to a line Y3 that is an extended line of thecenter line Y1 of the flexible tube 21. In the state where the curvedneedle 40 grasped by the first grasping surface 25 and the secondgrasping surface 27, a grasped region (center region P1 including agrasping portion P2 to be later) of the curved needle 40 grasped by thefirst grasping surface 25 and the second grasping surface 27 ispositioned between the distal end 26 a of the second grasping member 26and a needle tip 41 of the curved needle 40 in the center axis directionof the flexible tube 21.

Specifically, the second grasping surface 27 inclines from a proximalend 27 b of the second grasping surface 27 toward a distal end 27 a sidesuch that a distal end 27 a side of the second grasping surface 27approach the first grasping member 23 with respect to the center line Y1of the flexible tube 21. For example, the second grasping surface 27 mayincline linearly when viewing from the longitudinal axis direction of arotation axis Y2.

The second grasping surface 27 inclines in a predetermined angle θ1 thatis a range of 5° (degree) or more and 20° (degree) or less with respectthe line Y3 that is an extended line of the center line Y1 of theflexible tube 21 when viewing from a direction in which the rotationaxis Y2 of the therapeutic portion 22 extends. The second graspingsurface 27 is different from a convexoconcave for a slip resistance, andis provided at a predetermined region in the vicinity of the distal end26 a of the second grasping member 26 as a flat surface for grasping thecurved needle 40.

The connecting part 28 includes a hole portion 28 a for coupling andfixing the coupling shaft 29. The center line Y2 of the coupling shaft29 coupled with the connecting part 28 extends in a directionperpendicular to the line Y3 that is an extended line of the center lineY1 of the flexible tube 21. The first grasping member 23 is capable ofrotating around the rotation axis Y2 that is a line as the rotation axisY2 (the rotation axis Y2 of the coupling shaft 29) extending in adirection that is perpendicular to the center line Y1 of the flexibletube 21 because the first grasping member 23 and the second graspingmember 26 are coupled by the hole portions 23 c, 28 a and the couplingshaft 29. Thereby, the first grasping member 23 is capable of openingand closing with respect to the second grasping member 26. That is, thetherapeutic portion 22 of the present embodiment is a single swingtherapeutic portion in which the first grasping member 23 is open andclose with respect to the second grasping member 26 coupled with thedistal end 21 a of the flexible tube 21 via the connecting part 28 andthe coupling shaft 29.

As shown in FIG. 2, the operating portion 31 includes an operatingportion main body 32, a slider 33, a fixing mechanism (ratchet mechanismor the like, not shown) which limits that a slider 33 moves to thedistal end side with respect to the operating portion main body 32, anda release button 34 of the fixing mechanism.

A distal end 32 a of the operating portion main body 32 is fixed to theproximal end 21 b of the flexible tube 21. The slider 33 is coupled soas to be advanced and retracted in a longitudinal direction of theoperating portion main body with respect to the operating portion mainbody 32. Furthermore, the slider 33 is coupled with a proximal end 35 bof the operating wire 35. The operating wire 35 can be moved along thecenter line Y1 of the flexible tube 21 by advancing and retracting theslider 33 along the operating portion main body 32. In the presentinvention, the operating wire 35 can be towed toward the operatingportion 31 side by moving the slider 33 toward the proximal end sidealong the operating portion main body 32. The slider 33 is capable oflimiting the movement toward the proximal end side at the predeterminedposition by the fixing mechanism. Accordingly, the slider 33 is lockedin a state where the slider 33 tows the operating wire 35, and the statewhere the operating wire 35 tows can be maintained.

As shown in FIGS. 2 and 3, the operating wire 35 is a flexible wire fortransmitting operating force amount for performing the opening-closingoperation of the first grasping member 23 with respect to the secondgrasping member 26 form the operating portion 31 to the first graspingmember 23. The distal end 35 a of the operating wire 35 is connected tothe proximal end 23 b of the first grasping member 23. The proximal end35 b of the operating wire 35 is connected to the slider 33 of theoperating portion 31. It is difficult for the operating wire 35 toelongate in the longitudinal direction of the operating wire 35, and theoperating wire 35 can deform such that the longitudinal axis line of theoperating wire 35 bends. The operating wire 35 is towed toward theoperating portion 31 side, thereby the first grasping member 23 moves toa closing direction with respect to the second grasping member 26. Theoperating wire 35 is towed toward the operating portion 31 side, therebythe grasping force amount of the curved needle 40 by the first graspingmember 23 and the second grasping member 26 occurs.

As shown in FIG. 4 to FIG. 7, the curved needle 40 is an arc shapehaving a predetermined curvature. The curved needle 40 includes theneedle tip 41 that is capable of being inserted into the tissue, aneedle root part 42 that is coupled with the suture thread, and a needlemain body 43 that is arranged between the needle tip 41 and the needleroot part 42 so as to connect the needle tip 41 and the needle root part42.

As shown in FIG. 4 and FIG. 5, the needle main body 43 (curved needle40) includes a flat portion 44 in which at least a portion of an outercircumference of the curved needle 40 is formed flatly in across-section perpendicular to the center line Z1 extending along an arcof the curved needle 40.

Thereby, in a state where the curved needle 40 is grasped by the firstgrasping surface 25 and the second grasping surface 27, the flat portion44 is contacted to at least one of the first grasping surface 25 and thesecond grasping surface 27, thereby an orientation of the curved needle40 can be restricted such that the needle tip 41 is positioned closer tothe proximal end side than the flat portion 44.

The flat portion 44, more specifically, includes a first flat portion 44a and a second flat portion 44 b.

The first flat portion 44 a is formed inside (closer to a center ofcurvature O1 of the curved needle 40) of a bending part of the curvedneedle 40 among the outer circumference of the needle main body 43 in across-section perpendicular to the center line Z1 extending along thearc of the curved needle 40.

The second flat portion 44 b is formed outside (away from the center ofcurvature O1 of the curved needle 40) of a bending part of the curvedneedle 40 among the outer circumference of the needle main body 43 in across-section perpendicular to the center line Z1 extending along thearc of the curved needle 40.

The operation of the suture system 1 of the present embodiment will bedescribed. FIG. 8 is a view showing a state where the needle holder 20is inserted into a flexible endoscope 2.

In a state where the tissue in the body is sutured using the suturesystem 1 of the present embodiment. The curved needle 40 introduced to avicinity of a target to be sutured is grasped using the needle holder 20under the endoscope.

To grasp the curved needle 40 at the orientation appropriate forsuturing, an operator of the needle holder 20 grasps the curved needle40 using the operating portion 31 such that the needle main body 43 ofthe curved needle 40 is position between the first grasping member 23and the second grasping member 26. For example, the operator slightlytows the slider 33 toward the proximal end side of the operating portion31 and moves the first grasping member 23 toward the second graspingmember 26 side, thereby the needle main body 43 of the curved needle 40is grasped. As shown in FIG. 6 and FIG. 7, in a state where the firstflat portion 44 a is contacted to the first grasping surface 25 and thesecond flat portion 44 b is contacted to the second grasping surface 27,a position of the carved needle 40 becomes stable in a state where theneedle tip 41 is inclined toward the proximal end slightly. In thisstate, when the operator further tows the slider 33, the movement of thedistal end side of the slider 33 is limited by the fixing mechanism.Accordingly, the state where the curved needle 40 is grasped by thefirst grasping member 23 and the second grasping member 26 is held suchthat the curved needle 40 does not rotate.

In the present invention, the curved needle 40 can be grasped by thefirst grasping member 23 and the second grasping member 26 such that thesecond flat portion 44 b is contacted to the first grasping surface 25and the first flat portion 44 a is contacted to the second graspingsurface 27. However, a preferable grasping state of the curved needle 40of the present embodiment is the state where the first flat portion 44 ais contacted to the first grasping surface 25 and the second flatportion 44 b is contacted to the second grasping surface 27.

In a state where the curved needle 40 is grasped by the needle holder 20such that the first flat portion 44 a is contacted to the first graspingmember 23 and the second flat portion 44 b is contacted to the secondgrasping member 26, when the movement of the slider 33 is limited suchthat the slider 33 does not move to the distal end side, the secondgrasping member 26 restricts the orientation of the curved needle 40such that the needle tip 41 is positioned closer to the proximal endthan the second flat portion 44 b.

In the present embodiment, a center line X2 of the distal end opening 7a of the instrument channel 7 of the flexible endoscope 2 is away fromthe optical axis X1 so as to be approximately parallel to the opticalaxis X1 of the imager 4. Thereby, the distal end portion of the needleholder 20 that is projected from the distal end opening 7 a of theinstrument channel 7 is projected to the distal end side approximatelyparallel to the optical axis X1. In this state, as shown in FIG. 8 by achain double-dashed line, when the curved needle 40 is grasped by theneedle holder 20 such that a center line Z1 a of the curved needle 40 ispositioned in a plane perpendicular to the line Y3 that is an extendedline of the center line Y1 of the flexible tube 21, there is a case inwhich it may seem that a distance to the needle main body 43 of thecurved needle 40 and a distance to the needle tip 41 of the curvedneedle 40 are extremely different in the image captured by the imager 4of the flexible endoscope 2.

In a case in which the needle holder 20 is inserted into the flexibleendoscope 2 and the tissue is sutured by the needle holder 20, in apuncture process to the tissue to be sutured, the needle tip 41 of thecurved needle 40 moves from a position closer to the optical axis X1(see FIG. 8) toward the tissue T away from the optical axis X1 becausethe target tissue is treated during captured the target tissue to besutured in a lower side of the endoscope image. In this time, as shownin FIG. 8 by a chain double-dashed line, when the center line Z1 a ofthe curved needle 40 is positioned in a plane perpendicular to the lineY3 that is an extended line of the center line Y1, it seems that theneedle tip 41 moves further away from an actual position on theendoscope image. Consequently, when the tissue is sutured under theendoscope in the state where the curved needle 40 is grasped by theneedle holder 20 such that the center line Z1 of the curved needle 40 ispositioned in a plane perpendicular to the line Y3, there is apossibility that the operator of the needle holder 20 deeply inserts theneedle tip 41 into the tissue than intended by misidentifying theposition of the needle tip 41 in the optical axis X1 direction of theimager 4.

When the tissue is sutured under the endoscope in the state where thecurved needle 40 is grasped by the needle holder 20 such that a centerline Z1 a of the curved needle 40 is positioned in a plane perpendicularto the line Y3 that is an extended line of the center line Y1 of theflexible tube 21, an angle in which the needle tip 41 inserts into thetissue is deep than the intended angle and there is a possibility thatthe tissue is inserted more deeply than necessary because the punctureresistance of the needle tip 41 is more reduced than intended.

On the other hand, in the present invention, as shown in FIG. 6, itseems that a distance to the needle tip 41 is nearly the same as thedistance to the needle main body 43 on the image captured by the imager4 of the flexible endoscope 2 because the needle tip 41 faces theproximal end side more than the second flat portion 44 b. Consequently,the distance between the needle tip 41 of the curved needle 40 graspedby the needle holder 20 of the present embodiment and the imager 4 canbe easily obtained. As a result, according to the suture system 1 of thepresent embodiment, the possibility of inserting the curved needle 40into the tissue more deeply than intended can be reduced.

In the present embodiment, the suture system 1 has the curved needle 40that includes the first flat portion 44 a and the second flat portion 44b, thereby in addition to contacting the second flat portion 44 b to thesecond grasping surface 27 and restricting the orientation of the curvedneedle 40, the orientation of the curved needle 40 is capable ofrestricting by contacting the first flat portion 44 a to the firstgrasping surface 25. Consequently, according to the suture system 1 ofthe present embodiment, compared to a case where only the second flatportion 44 b is formed in the curved needle 40, the curved needle 40 canbe held with more stability. The suture set has the needle holder 20 ofthe present invention and the curved needle 40 including the first flatportion 44 a and the second flat portion 44 b performs with the aboveefficiency using combination with a known flexible endoscope.

Modified Example 1

A modified example of the above first embodiment will be described. FIG.9 is a lateral view showing the treatment portion in the needle holderof a modified example of the embodiment.

As shown in FIG. 9, the first grasping member 23 of the present modifiedexample includes the first grasping surface 25A. A configuration of thefirst grasping surface 25A is different from a configuration of thefirst grasping surface 25 that is disclosed in the above firstembodiment.

The first grasping surface 25A of the modified example is bend so as toapproach gradually the second grasping member 26 side from the proximalend 23 b of the first grasping member 23 to the distal end 23 a side ina vicinity of the distal end 23 a. The first grasping surface 25A of themodified example limits the movement of the curved needle 40 to thedistal end side of the therapeutic portion 22 by the holding force inthe state where the curved needle 40 is grasped by the first graspingmember 23 and the second grasping member 26. Accordingly, in the presentmodified example, even if the towing force of the operating wire 35 islarge, the curved needle 40 can be reliably grasped by the firstgrasping member 23 and the second grasping member 26.

Modified Example 2

Another modified example of the above first embodiment will bedescribed. FIG. 10 is a lateral view showing the treatment portion inthe needle holder of another modified example of the embodiment. FIG. 11is a view showing the treatment portion in the needle holder of themodified example of the embodiment from a C direction of FIG. 10.

As shown in FIG. 10 and FIG. 11, the second grasping member 26 of thepresent modified example includes a projection portion 39 that isprojected from the distal end 27 a of the second grasping surface 27 tothe first grasping surface 25 side.

The projection portion 39 can support the curved needle 40, in the statewhere the curved needle 40 is grasped by the first grasping member 23and the second grasping member 26, such that the curved needle 40 movesto the distal end side of the therapeutic portion 22 and the curvedneedle 40 does not fall from between the first grasping member 23 andthe second grasping member 26.

The projection portion 39 of the modified example includes a recessedportion 39 a in which the distal end 23 a of the first grasping member23 enters. The recessed portion 39 a is provides in the projectionportion 39, thereby the curved needle 40 of which a diameter is smallthan a distance between the second grasping surface 27 to a projectionend of the projection portion 39 can be grasped by the first graspingmember 23 and the second grasping member 26.

Modified Example 3

Furthermore another modified example of the above first embodiment willbe described. FIG. 12 is a lateral view showing a state where the needleholder of further another modified example. FIG. 13 is a view showing amovement in which the curved needle is grasped and a tissue is suturedusing the needle holder of the modified example.

As shown in FIG. 12 and FIG. 13, the suture system 1 of the presentmodified example includes an optimized needle holder 20A thatcorresponds to the instrument channel 7 of the flexible endoscope 2 anda configuration of the imager 4.

In the present modified example, a second grasping surface 27A formed inthe second grasping member 26, in a state where an arbitrary graspedportion P2 is grasped among the center region P1 of the needle main body43 of the curved needle 40 between the first grasping member 23 and thesecond grasping member 26, restricts the orientation of the curvedneedle 40 such that a first straight-line distance L1 from the imager 4to the grasped portion P2 is equivalent to a second straight-linedistance L2 from the imager 4 to the needle tip 41 of the curved needle40. The center region P1, for example, is a region from a middle point Mbetween the needle tip 41 and the needle root part 42 on the center lineZ1 of the curved needle 40 to a predetermined angle γ to the needle rootpart 42 side around a center of curvature O1 of the curved needle 40.For example, the predetermined angle γ is 30 degrees.

In the present modified example, the second grasping surface 27A is aconstant angle θ2 with respect to the line Y3 that is an extended lineof the center line Y1 of the flexible tube 21 when viewing a directionin which the rotation axis Y2 of the therapeutic portion 22 extends. Theabove constant angle θ2 is set in accordance with a configuration ofinstrument channel 7 of the flexible endoscope 2 and the imager 4.

In the present modified example, because the second grasping surface 27Ais the optimized constant angle θ2 in the configuration of the flexibleendoscope 2 that is used along with the needle holder 20 of the epresent modified example, in a process of rotating the therapeuticportion 22 around the center line Y1 of the flexible sheath portion 21and inserting the needle tip 41 into the tissue, a variation of thedistance of the needle tip 41 is further reduced on the image capturedby the imager 4. Accordingly, in the present modified example, amisconception of a sense of distance of the needle tip 41 in the processof inserting the needle tip 41 into the tissue is hardly to occur.

Second Embodiment

The second embodiment of the present invention will be described. FIG.14 is a plan view showing a second grasping surface of a needle holderof a second embodiment of the present invention. FIG. 15 is a front viewshowing a treatment portion of the embodiment.

As shown in FIG. 14 and FIG. 15, the needle holder 20B of the presentembodiment a second grasping member 36 instead of the second graspingmember 26 disclosed in the above first embodiment. A configuration ofthe second grasping member 36 is different from that of the secondgrasping member 26.

The second grasping member 36 of the embodiment includes a secondgrasping surface 37 that is contacted to the second flat portion 44 b ofthe curved needle 40 similar to the first embodiment. The secondgrasping member 36 includes a groove part 38 that extends from a distalend 36 a of the second grasping member 36 toward a proximal end 36 b ofthe second grasping member 36. In the present embodiment, the secondgrasping surface 37 is separated into two parts by the groove part 38.The second grasping surface 37 includes the groove part 38 and boundaryparts 37 a and 37 b. In the present embodiment, the boundary parts 37 aand 37 b is an edge of a groove that extends in a longitudinal directionof the groove part 38 at a position intersecting with the secondgrasping surface 37 and the groove part 38, the edge may be a cornerportion, may be a shape in which the corner portion is chamfered, andmay be formed into a round shape instead of the corner portion.

The groove part 38 linearly extends from the distal end 36 a of thesecond grasping member 36 toward the proximal end 36 b of the secondgrasping member 36.

The second flat portion 44 b of the curved needle 40 is supported by theboundary parts 37 a and 37 b by two points (positions indicated byreference signs A1 and A2 in FIG. 15) that is away from each other bycontacting the needle main body 43 of the curved needle 40 with thegroove part 38 and the boundary parts 37 a and 37 b of the secondgrasping 27.

When the first grasping member 23 is closed similar to the above firstembodiment in a state where the second flat portion 44 b is supported bythe boundary parts 37 a and 37 b, the first grasping member 23 contactto the first flat portion 44 a of the curved needle 40. When viewingfrom the distal end 36 a of the second grasping member 36 toward theproximal end 36 b of the second grasping member 36, the first flatportion 44 a of the curved needle 40 is supported by the first graspingsurface 25 of the first grasping member 23 in two portions (positionsindicated by reference signs A3 and A4 in FIG. 15) that are positionedto sandwich between the above two portions (A1, A2).

In the present embodiment, because the second flat portion 44 b that isformed outside in the curving portion of the curved needle 40 among theouter circumference of the curved needle 40 is supported by the boundaryparts 37 a and 37 b at two portion (A1, A2) that are away from eachother, the orientation of the curved needle 40 in the state where thecurved needle 40 is grasped by the first grasping member 23 and thesecond grasping member 36 can be more stable than in the firstembodiment.

The embodiment of the present invention will be described based on thedrawings. The specific configuration is not limited by this embodiment,other modifications of components can be made without departing from theconcept of the invention.

For example, the needle holder 20 disclosed in each embodiment may beused along with an endoscope that is different from the above flexibleendoscope 2. For example, the needle holder 20 disclosed in eachembodiment may be used along with a side view type endoscope.

The operating portion of the needle holder 20 disclosed in above eachembodiment may be a rigid shaft type of forceps like a laparoscopicforceps type in FIG. 17.

For example, as shown in FIG. 17, an operating portion 51 includes apair of handles (fixing handle 52 and movable handle 53) that arecapable of opening and closing, and a fixing mechanism (not shown) thatfixes the movable handle 53. The movable handle 53 is coupled with thefixing handle 52 so as to be capable of rotating around a predeterminedopening-closing shaft 53 a with respect to the fixing handle 52. Themovable handle 53 is coupled with the proximal end 35 b of the operatingwire 35. The operating wire 35 can be moved along the center line Y1 ofthe flexible sheath portion 21 by opening and closing the movable handle53 with respect to the fixing handle 52.

The proximal end 23 b of the first grasping member 23 of the needleholder 20 disclosed in above each embodiment, as shown in FIG. 18, maybe coupled with the distal end 35 a of the operating wire 35 via a linkfor coupling 61.

In the above second embodiment, the first grasping member may contact atone point (first flat surface) that is formed in the curved needle.

The effect disclosed in above each embodiment can be obtained even ifthe needle holder 20 of the above each embodiment combines with a knowncurved needle and endoscope.

A configuration disclosed in above each embodiment and the modifiedexample may be appropriately combined with each other.

For example, as shown in FIG. 16, the second grasping member 26disclosed in the above first embodiment may include the groove part 38and the projection portion 39.

What is claimed is:
 1. A needle holder comprising; a flexible sheathportion which is longitudinal, flexible, and capable of being insertedinto an instrument channel of a flexible endoscope; a first graspingmember which has a first grasping surface and is rotatably coupled witha distal end portion of the flexible sheath portion; and a secondgrasping member which has a second grasping surface and is provided inthe distal end portion of the flexible sheath portion, wherein thesecond grasping surface inclines from a proximal end of the secondgrasping surface toward a distal end side of the second graspingsurface, the distal end of the second grasping surface is closer to thefirst grasping member than the proximal end of the second graspingsurface, and in a state where a grasped region of a curved needle isgrasped by the first grasping surface and the second grasping surface, aneedle tip of the curved needle positions closer to a proximal end ofthe flexible sheath portion than the grasped region of the curvedneedle.
 2. The needle holder according to claim 1, wherein the secondgrasping surface inclines in a range of 5° or more and 20° or less froma center axis of the flexible sheath portion.
 3. The needle holderaccording to claim 1, wherein the second grasping member includes aprojection portion that projects from a distal end of the secondgrasping surface to the first grasping member side.
 4. The needle holderaccording to claim 1, wherein the second grasping member includes agroove part that extends from a distal end of the second graspingsurface toward a proximal end of the second grasping surface, and awidth of the groove part is larger than a width of the first graspingsurface in a direction perpendicular to a center axis of the flexiblesheath portion.
 5. A suture set comprising; the needle holder of claim1; and a curved needle that is grasped by the needle holder, wherein thecurved needle includes a flat portion which is at least a portion of anouter circumference of the curved needle and is formed flatly in across-section perpendicular to a center axis extending along an arc ofthe curved needle, and in a state where the grasped region of the curvedneedle is grasped by the first grasping surface of the first graspingmember and the second grasping surface of the second grasping member, anorientation of the curved needle is restricted such that the needle tipis positioned closer to a proximal end side than the flat portion bycontacting the flat portion to at least one of the first graspingsurface and the second grasping surface.
 6. A suture system comprising;the needle holder of claim 1; and an endoscope that includes: aninstrument channel into which the flexible sheath portion is inserted,and an imager that is configured to capture at least the first graspingmember and the second grasping member among the needle holder projectedfrom a distal end of the instrument channel, wherein in a state wherethe curved needle is grasped between the first grasping member and thesecond grasping member, the second grasping surface inclines with anangle in which an orientation of the curved needle is configured torestrict such that a first straight-line distance from the imager to acenter portion of the curved needle is equivalent to a secondstraight-line distance from the imager to a needle tip of the curvedneedle.